Audiology Lecture 2

Age of patient, cause of the loss, severity of loss

Impairment refers to a structural abnormality, while disability refers to a functional limitation

Handicap refers to the inability to function at the same level as peers

It provides valuable information about the patient's concerns and reasons for seeking help

Self-perceived difficulty, disgruntled family member, teacher complaints

Pre/postnatal history, NICU stay, newborn hearing screening (NBHS), ear infections, family history, speech/language development, developmental milestones

It provides valuable information about any potential risk factors or complications that may have affected the child's hearing

a) It helps determine if there are any underlying medical conditions that may be related to the child's hearing or communication difficulties.

b) It helps establish a baseline for the child's overall health and well-being.

c) It allows the audiologist to make appropriate referrals to other healthcare professionals if necessary.

a) It helps determine if the child has any hearing difficulties or auditory processing issues.

b) It helps establish a baseline for the child's auditory abilities and sensitivity to sound.

c) It allows the audiologist to assess if there are any behavioral or emotional reactions to specific sounds.

a) It helps determine the child's level of physical activity and overall engagement in recreational activities.

b) It allows the audiologist to assess if there are any potential exposure to noise or activities that may impact the child's hearing.

c) It provides insight into the child's interests and hobbies, which may have an impact on their communication needs.

a) Are they single, married, or do they have small children?

b) Are there any specific communication challenges or difficulties in the home environment?

c) Are there any noise or environmental factors that may impact the individual's hearing or communication abilities at home?

a) It helps determine if the individual's hearing or communication difficulties are affecting their work performance or job responsibilities.

b) It provides insight into the communication demands and settings the individual encounters in their workplace.

c) It allows the audiologist to assess if there are any potential noise or occupational exposure risks that may impact the individual's hearing.

a) What hobbies or recreational activities does the individual engage in?

b) Are there any specific situations or environments where the individual struggles with hearing or communication?

c) Does the individual use any assistive listening devices or strategies during their extra activities?

a) It helps determine the duration and progression of the hearing or communication difficulties.

b) It provides a baseline for tracking any changes or improvements over time. c) It allows the audiologist to assess if there are any potential underlying causes or factors contributing to the problem.

a) It helps identify if there are any fluctuating or progressive components to the hearing loss.

b) It provides insight into the potential causes or triggers for the changes in hearing.

c) It allows the audiologist to determine if there are any specific patterns or factors influencing the variability in hearing.

a) It helps establish a baseline of their previous hearing assessment results and interventions.

b) It provides insight into the progression or changes in their hearing status over time.

c) It allows the audiologist to determine if any previous recommendations or interventions were implemented and their effectiveness.

a) It helps determine if the individual is already using amplification to address their hearing loss.

b) It provides information about their experience with hearing aids and any specific challenges they may have encountered.

c) It allows the audiologist to assess the effectiveness of the current hearing aids and if any adjustments or upgrades are needed.

a) It helps identify if there is a genetic predisposition to hearing loss or other related conditions.

b) It provides insight into potential environmental or lifestyle factors that may contribute to hearing difficulties.

c) It allows the audiologist to assess if other family members have sought treatment for hearing loss.

a) It helps determine if the hearing difficulties are specific to certain environments or situations.

b) It provides insight into the communication challenges the individual encounters in their daily life.

c) It allows the audiologist to assess if there are any specific factors or triggers that contribute to the difficulty.

a) It allows us to visualize the external ear canal and assess its condition.

b) It helps identify any abnormalities, such as wax buildup, foreign objects, or inflammation, in the ear canal.

c) It provides a view of the tympanic membrane (eardrum) and helps evaluate its integrity and appearance.

a) Wax or debris accumulation in the ear canal

b) Signs of infection or inflammation, such as redness or swelling

c) Presence of a foreign object in the ear canal

d) Condition and appearance of the tympanic membrane (eardrum)

a) Bracing ensures a steady hand and prevents accidental injury to the ear canal or tympanic membrane.

b) It helps maintain a clear view of the ear and improves the accuracy of the examination.

c) Bracing minimizes the risk of discomfort or pain for the patient during the procedure

Dispose of otoscope tips after each use to minimize the risk of cross-contamination.

0 daPa

a) The pressure in the ear canal is equal to the pressure in the middle ear.

b) The Eustachian tube is functioning properly, allowing for equalization of pressure.

c) It suggests normal middle ear function and proper Eustachian tube opening and closing.

a) To ensure accurate measurement of pressure in the ear canal.

b) To prevent any air leaks that could affect the results.

c) An airtight seal helps create a closed system for pressure measurement.

a) To differentiate between different sizes of probe tips.

b) To allow for easy identification and organization of probe tips.

c) Different colors may be used for different patients or for infection control purposes.

Probe assembly - The probe goes into the eardrum

transducer - to give the probe tone output

air pump - to change the pressure in the ear canal

microphone - to measure the sound that is reflected back from the ear drum

the mobility of the middle ear in response to a change in pressure.

+200 to -400 daPa.

The X-axis in tympanometry represents the air pressure, ranging from negative to positive values.

The Y-axis in tympanometry represents compliance, which is a measure of the middle ear's mobility.

Within normal limits, the compliance should fall between -150 and +150 daPa.

A compliance value less than -150 daPa indicates an issue with equalizing pressure on both sides of the eardrum.

Eustachian tube dysfunction and resolving otitis media can be associated with a compliance value less than -150 daPa.

A Type A tympanogram indicates a nice, normal response. The compliance is within the range of normal, and the pressure falls between -150 and +150 daPa.

A Type C tympanogram indicates that the compliance is normal, but the pressure is greater than -150 daPa, indicating negative pressure in the middle ear.

A Type B tympanogram indicates zero compliance, with no eardrum movement at all. This can be associated with conditions such as fluid or a perforation.

A Type B tympanogram can be associated with conditions such as fluid in the middle ear or a perforation of the eardrum.

A Type Ad tympanogram indicates that the pressure is normal, but the compliance is hypercompliant, meaning it is higher than the normal range.

A Type As tympanogram indicates that the pressure is normal, but the compliance is hypocompliant, meaning it is lower than the normal range.

The typical range of ear canal volume for adults is 0.6-1.5 cm3.

The typical range of ear canal volume for children is 0.4-1.0 cm3.

Factors such as earwax blockage or narrowing of the ear canal can result in a lower ear canal volume.

Factors such as inflammation or swelling of the ear canal, presence of a foreign object, or abnormal growths can lead to a higher ear canal volume.

An acoustic reflex is an involuntary response of the stapedius muscle in the middle ear to an external sound stimulus.

Measuring the acoustic reflex can provide information about the integrity of the auditory system and help in the diagnosis of certain hearing disorders.

The sound is delivered through the probe into the ear canal and reaches the tympanic membrane (TM). The sound stimulation then travels through the middle ear, cochlea, and eighth nerve to the brainstem. Specifically, it reaches the ventral cochlear nucleus and the superior olivary complex. From there, the signal is transmitted to the facial nerve (CN VII), which ultimately controls the movement of the stapedius muscle.

In the measurement of acoustic reflex thresholds, we are determining the lowest intensity level of sound required to elicit a contraction of the stapedial reflex.

The stapedial reflex, when activated, causes the stapedius muscle in the middle ear to contract. This contraction stiffens the ossicular chain and reduces the transmission of sound through the middle ear, protecting the inner ear from loud sounds.

The stapedial reflex is typically triggered by a loud sound. It contracts in response to intense acoustic stimulation, serving as a protective mechanism against potentially damaging sound levels.

This means that a loud sound presented in one ear can elicit a reflexive contraction in both ears. The contraction occurs on the same side (ipsilateral) as the ear where the sound stimulus is presented and also on the opposite side (contralateral).

The acoustic reflex threshold in normal ears typically falls between 65-95 dB HL (hearing level).

Conductive losses may result in either no response or a higher than normal threshold in the acoustic reflex test. The increased mass and impedance of the middle ear system in conductive losses make it more challenging to stimulate the stapedial reflex.

In cases of sensorineural hearing loss, the acoustic reflex may be elevated or absent. Due to the elevated thresholds in sensorineural loss, higher presentation levels are required to elicit the reflex response. If the thresholds are already elevated, the intensity limits of the measurement equipment may be reached before a response can be obtained.

Adults and individuals over the age of 3 typically use a 226Hz probe tone to obtain a tympanogram.

Pediatric patients under the age of 3 require a 1000Hz probe tone for obtaining a tympanogram.

The middle ear in young children is not fully developed, and the acoustic properties differ from those in adults. Therefore, a higher probe tone frequency (1000Hz) is used to better assess the middle ear function in pediatric patients.

An audiometer is used to generate pure tone signals for the purpose of conducting hearing tests and evaluations.

An audiometer typically has 2 channels.

The ability to send two different signals to each ear simultaneously. This allows for independent testing of each ear and enables binaural hearing assessments.

The stimulus options in an audiometer include pure tones, warbled tones, frequency modulated "FM" tones, speech signals, and the ability to connect external stimulus sources.

–Inserts

–Supra aural

–Bone oscillator

–Speakers

The routing options on an audiometer allow the operator to select whether the signal will be presented to the right ear, left ear, or both ears simultaneously. This allows for independent testing of each ear or binaural testing when necessary.

The attenuator dial on an audiometer is used to control and adjust the intensity or loudness of the signal that is being delivered to the patient. It allows the operator to increase or decrease the sound level according to the patient's responses or specific testing requirements.

The presentation button on an audiometer is used to introduce the signal or stimulus to the patient. When pressed, it initiates the delivery of the sound or tone to the earphones or speakers, allowing the patient to respond to the stimulus during the hearing test.

The frequency selection button on an audiometer is used to choose the specific frequency or pitch of the pure tone that will be presented to the patient during the hearing test. It allows the operator to select different frequencies to evaluate the patient's hearing sensitivity at various points across the audible frequency range.

A sound-treated booth.

It has double walls with double doors and sound-attenuating materials between the walls.

Lighting that does not buzz or hum.

They are equipped with sound attenuation.

To reduce reverberation and echo.

It is slightly elevated to reduce vibrations from the ground.

To enhance sound insulation and minimize external noise.

To determine the lowest threshold of hearing for the patient at different frequencies.

The softest level is the one detected 50% of the time by the patient.

The audiometer can change frequency from 250Hz to 8000Hz.

The dial allows for the adjustment of stimulus presentation, increasing or decreasing the intensity of the sound.

Pure tones, modulated tones, and pulsed tones can be used as stimulus options.

Audiologists can talk to patients through the headset connected to the audiometer.

Audiologists can hear patients using a talkback microphone connected to the audiometer.

To ensure they respond even if the sound is very faint.

No, they should respond even if the sound is very faint.

Suprathreshold.

Their hearing loss may be perceived as more severe than it actually is.

They can use hand raising, button pressing, or verbal responses.

1-2 seconds.

More than 2 seconds.

An intensity that is audible to the patient, typically 30 dB.

Increase the intensity to 50 dB.

Increase the intensity by 10 dB until the patient responds.

Clinically, we use 5 dB steps (e.g., 35, 40, 45 dB, etc.).

It involves a "down 10, up 5" procedure. The intensity is decreased by 10 dB after the patient responds and increased by 5 dB after the patient does not respond.

The goal is to obtain 2 out of 3 responses on the ascending search.

The intensity should be decreased by 10 dB and the tone should be presented again.

The intensity is increased by 5 dB to find the threshold.

The frequency range is usually from 250 Hz to 8000 Hz.

We start the testing at 1000 Hz.

The frequencies tested after 1000 Hz are 2000 Hz, 3000 Hz, 4000 Hz, 6000 Hz, and 8000 Hz.

Retesting at these frequencies helps to ensure accurate results and verify the patient's hearing thresholds.